Rosacea is a common and chronic skin disorder that causes redness and pimples on the nose, forehead, cheeks, chin and sometimes the eyes.
Because it is commonly mistaken for acne, it is sometimes called acne rosacea or adult acne. However, unlike acne, rosacea rarely causes blackheads. It usually starts with redness on the cheeks and nose and later affects the forehead and chin.
In most people, rosacea is cyclical. This means that patients experience symptoms for a period of weeks or months. The symptoms fade over time and then flare up again in the future. The condition often occurs in three phases, with symptoms growing progressively worse with each phase.
Rosacea is not a life-threatening condition, but it can cause emotional problems. Some people experience embarrassment or low self-esteem because of changes in the appearance of their skin. Others have difficulty with social interactions or experience depression, which is a mood disorder characterized by extreme feelings of sadness, pessimism and inadequacy.
About 14 million Americans have rosacea, according to the National Rosacea Society. It usually affects adults ages 30 to 50. Although it affects all segments of the population, people with fair skin who blush (sudden reddening of the face often due to shame or embarrassment) easily are impacted more frequently. It is more common in women (particularly during menopause), but men tend to have more severe symptoms.
No research has been conducted to determine whether rosacea is hereditary, but in a survey conducted by the National Rosacea Society, 40 percent of patients said they could name a relative who had similar symptoms.
Also, there is evidence that ethnicity may play a role in developing rosacea. In another study by the National Rosacea Society, over half of respondents reported having parents of Irish or English descent.
There are several different types of rosacea. Most patients experience characteristics of more than one type. They include:
Characterized by blushing (sudden reddening of the face often due to shame or embarrassment) and persistent redness. May also include visible blood vessels.
Characterized by persistent redness with transient bumps and pimples. May occur along with acne in some patients.
Characterized by skin thickening, often resulting in enlargement of the nose (rhinophyma) from excess tissue.
Characterized by dry eyes, tearing and burning, swollen eyelids, recurrent sties (eyelid infection) and potential vision loss from damage to the cornea.
Characterized by hard, yellow, brown or red papules (small, solid and usually inflammatory bumps on the skin) or nodules (small masses of tissue that are usually painless) that may be severe and lead to scarring.
The cause of rosacea is unknown. There are several theories about its origin, but none have been confirmed with scientific research. It is possible that rosacea is the result of a disorder that causes blood vessels in the face to swell. This theory may explain why individuals with rosacea have a greater tendency to blush.
According to another theory, rosacea may be caused by an infection of the Helicobacter pylori bacteria in the gastrointestinal system. Other theories include the presence of mites living in hair follicles, fungus, a malfunction of the connective tissue under the skin or psychological factors.
A rosacea flare-up may be triggered by a number of factors. It is important to note, however, that factors that cause flare-ups in one person may have no effect on another person. In addition, these factors contribute to flare-ups and are not necessarily the underlying cause.
- Hot or spicy foods or beverages
- Hot or cold temperatures
- Hot baths or saunas
- Sun exposure
- Emotional stress, anger or embarrassment
- Strenuous exercise
- Long-term use of topical corticosteroids on the face
- Drugs that open the blood vessels (such as some blood pressure medications)
Signs and symptoms of rosacea vary among patients.
- Persistent redness (erythema). This is the most common sign of rosacea and may resemble a sunburn that does not disappear.
- Blushing. People who blush (sudden reddening of the face often due to shame or embarrassment) easily are more apt to develop rosacea. This is often the earliest sign of the condition.
- Bumps and pimples. Small red bumps or pus-filled pimples may develop on the nose, cheeks, forehead and chin. These are different than the whiteheads and blackheads that commonly develop with acne.
- Visible blood vessels. Small blood vessels sometimes become visible on the skin in people with rosacea.
- Eye irritation. In patients with ocular rosacea, the eyes may be irritated and appear watery or bloodshot. The eyelids may become red and swollen, and sties (eyelid infection) are common. If left untreated, severe cases can result in corneal damage or vision loss.
- Burning or stinging. May occur on the face. Itching or a feeling of tightness may also occur.
- Dry appearance of the skin. The central facial skin may be rough and very dry.
- Plaques. Raised, red patches may develop without changes in the surrounding skin.
- Skin thickening. The skin (usually on the nose) may thicken and become enlarged from excess skin. This condition is called rhinophyma and is experienced more frequently by men than women.
- Swelling (edema) of the face. May occur alone or develop with other signs of rosacea.
- Symptoms experienced outside the face. Areas outside of the face may be affected by rosacea, including the neck, chest, scalp or ears.
Each rosacea symptom may progress from mild to moderate to severe.
- Pre-rosacea. Rosacea usually begins with a tendency to flush or blush easily. Over time, the redness may persist in the central part of the face, particularly the nose. The redness is caused by the dilation of blood vessels near the skin’s surface.
- Vascular rosacea. Blood vessels in the nose and cheeks swell and become visible. This is called telangiectasia. The patient may experience oily, over-sensitive skin and dandruff.
- Inflammatory rosacea. Small, red bumps or pustules (small, inflamed, pus-filled blister-like lesions on the skin surface) may develop and remain on the nose, cheeks, forehead and chin.
To diagnose rosacea, a physician will typically compile a complete medical history and perform a physical examination. Patients may be treated by a dermatologist, which is a physician that specializes in the diagnosis and treatment of disorders of the skin, hair and nails.
The physician will visually inspect the skin and ask the patient questions about factors that worsen or improve symptoms. Sometimes tests will be performed to rule out other conditions and diseases, such as lupus (disease of the immune system), which may be causing symptoms.
Rosacea rarely disappears without treatment. In fact, it tends to get worse over time if left untreated. Although it cannot be cured, several treatment options exist that can control the redness, inflammation and skin eruptions commonly experienced with the condition. They include:
A physician may recommend moisturizers, soaps, sunscreens and other products to improve the overall health of the skin.
Prescription medication applied directly to the skin for both their anti-inflammatory qualities and antibacterial qualities.
Medication taken by mouth to kill bacteria. These tend to work faster than topical antibiotics. Sometimes, both topical and oral antibiotics are prescribed.
Certain acne medications may be prescribed for some patients instead of or along with antibiotics. These include topical sulfur and azelaic acid. In very severe cases of rosacea, the acne medication isotretinoin may be prescribed.
Extreme cases of rosacea, such as those that involve rhinophyma (thickening of the skin usually on the nose), may be treated with laser or electrosurgery. These techniques are used to reduce the visibility of enlarged blood vessels, remove tissue buildup around the nose and improve the overall appearance of the skin.
It may take several weeks, or even months of rosacea treatment before an improvement can be seen in the appearance of the skin.
Patients can use green-tinted cosmetics to conceal the affects of rosacea. A skin-toned foundation with a yellow hue can then be used over the green makeup. Cosmetics with pink or orange hues should be avoided.
The skin changes associated with rosacea can cause embarrassment and low self-esteem. Living with the condition can also lead to social problems and depression. Patients experiencing extreme sadness, or other signs of depression (e.g., lack of appetite, difficulty concentrating), should consult a physician.
Prevention methods for rosacea
Although rosacea cannot be prevented, many patients can avoid flare-ups by identifying the factors that cause them and avoiding these factors. Patients may benefit from keeping a written record of when their symptoms occur. After several weeks, patients should be able to review the data and identify patterns that indicate which factors trigger their flare-ups.
- Avoid irritating the skin by rubbing or touching it too much.
- Wear sunscreen with an SPF factor of 15 or higher to protect the skin from the sun.
- Protect the face from wind and cold temperatures during the winter by wearing a scarf or ski mask.
- Apply moisturizer to the skin after topical medication has dried.
- Avoid exercising too much or overheating.
- Avoid alcohol and spicy foods.
- Use relaxation techniques, such as yoga or deep breathing, to reduce stress.
Patients should discuss their skin care routine with their dermatologist. The physician can provide product recommendations and tips on how to cleanse the face without causing flare-ups.
- Avoid skin products that contain alcohol or other skin irritants. Mild and non-abrasive cleansers are a better choice.
- Ensure that topical products are noncomedogenic, meaning they will not clog pores as much as standard products.
- Use the fingertips to cleanse the face. Rough washcloths should be avoided.
- Use lukewarm water to rinse the face.
- Use a soft cotton towel to gently pat the skin dry.
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following rosacea-related questions:
- How can I tell the difference between acne and rosacea?
- Do my symptoms indicate rosacea?
- What type of rosacea do I have?
- What may have caused me to develop rosacea?
- Does rosacea pose any danger to my overall health?
- Is rosacea an ongoing condition, or can I expect it to eventually go away?
- What are my treatment options? How effective are they?
- What factors may be triggering my flare-ups?
- What steps can I take to control flare-ups?
- Are certain skin care products better for me than other?
- Are my children likely to develop this condition as well?